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Disability

Consent and Application for Remittance of Disability Benefits to an Insurer - Québec Pension Plan

Insurance companies can use this form to obtain an applicant's consent to the reimbursement of disability benefits to the insurer. This form is also used to file the insurer's application for remittance.

Important

By signing this form, you are agreeing to file an application subsequently for disability benefits with Retraite Québec. We recommend that you review the clauses of your contract with your insurance company because you may not be required to complete the form.

RRQ-004 form. Last update: November 2019.

Notice to disabled persons

This PDF document may contain barriers to accessibility. You can obtain assistance by calling us.
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